Tuesday, October 24, 2006

Surgeon General Misrepresented Conclusions of His Report Even in Summary of Report Conclusions

Previously, I reported that the Surgeon General misrepresented the conclusions of his 2006 report on the health consequences of involuntary smoking in his press release and ancillary press materials that accompanied the report. Here, I reveal that the Surgeon General misrepresents the conclusions of the report in his summary of the conclusions of the report itself.

In his summary of the 6 major conclusions of the report, the Surgeon General makes the following statements:

1. "Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack."

Here is why each of these statements is misleading and mis-representative of the actual conclusions of the Surgeon General's report.

1. "Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack."

It is true that breathing secondhand smoke for a short time can have immediate adverse effects on the cardiovascular system and one could reasonably state that these effects represent something other than normal functioning of the heart, blood, and vascular systems. However, there is not evidence that these effects, which have been shown to be transient, increase the risk of a heart attack.

The statement is misleading, then, because it suggests that the adverse acute effects of a brief exposure to secondhand smoke have been shown to increase the risk of a heart attack. This is simply not the case.

Moreover, even if the statement were accurate, it misrepresents the conclusions of the actual Surgeon General's report, which is devoid of any conclusion that short-term exposure to secondhand smoke increases heart attack risk.

If you read through or search the entire 727-page report, you will not find any conclusion that a brief exposure to secondhand smoke increases heart attack risk. And for good reason: there is no such evidence. The report itself is very carefully reviewed science and it is cautious in drawing causal conclusions. Not so the summary of the conclusions of the report provided by the Surgeon General.

It is as if the Surgeon General didn't even read his own report. It is as if he simply decided in advance the claims he wanted to make, and made them, regardless of whether there was evidence in the report to support them, or whether the report had drawn those conclusions.

It is important to add that even the speculation about the potential effects of a brief secondhand smoke exposure on heart attack risk apply only to people with severe existing coronary artery disease, who are essentially so fragile that virtually any insult (even eating a hamburger) could cause a heart attack. Without qualifying the claim to make it clear that it is referring only to people with severe coronary artery disease, the claim is very misleading.

It is true that short exposure to secondhand smoke can increase platelet aggregation, cause endothelial dysfunction (damage to the lining of blood vessels), decrease coronary velocity reserves, and reduce heart rate variability. However, there is not evidence that these effects, which have been shown to be transient, increase the risk of a heart attack.

The statement is misleading, then, because it suggests that the adverse acute effects of a brief exposure to secondhand smoke have been shown to increase the risk of a heart attack. This is simply not the case.

Moreover, even if the statement were accurate, it misrepresents the conclusions of the actual Surgeon General's report, which is devoid of any conclusion that short-term exposure to secondhand smoke increases heart attack risk.

If you read through or search the entire 727-page report, you will not find any conclusion that a brief exposure to secondhand smoke increases heart attack risk. And for good reason: there is no such evidence. The report itself is very carefully reviewed science and it is cautious in drawing causal conclusions. Not so the summary of the conclusions of the report provided by the Surgeon General.

Once again, it is as if the Surgeon General didn't even read his own report. It is as if he simply decided in advance the claims he wanted to make, and made them, regardless of whether there was evidence in the report to support them, or whether the report had drawn those conclusions.

It is important to add, again, that even the speculation about the potential effects of a brief secondhand smoke exposure on heart attack risk apply only to people with severe existing coronary artery disease, who are essentially so fragile that virtually any insult (even eating a hamburger) could cause a heart attack. Without qualifying the claim to make it clear that it is referring only to people with severe coronary artery disease, the claim is very misleading.

What This All Means

What this means is that there really wasn't much of a need for a 727-page report. If the Surgeon General was just going to communicate alarmist claims to the public that weren't in the report itself, why waste the effort preparing the 727 pages?

Well it occurs to me that there is a potential reason: to make it appear that the conclusions being communicated were carefully reviewed and scrutinized and that they are therefore not subject to questioning. There is no way that the public, or even most anti-smoking advocates or groups, are going to read through the entire 727-page report to figure out what claims made by the Surgeon General are well-documented and supported by the evidence and conclusions drawn in the report and which are not. By attaching what basically amounts to a propaganda statement along with the report, it makes it appear to all that these conclusions are documented, when in fact they are not.

Whether this is simply a serious mistake or an intentional attempt to deceive is not clear to me. But the effect is that anti-smoking groups across the country have ended up misrepresenting the science to the public, themselves deceived into thinking that these particular conclusions are rock solid.

For example, SmokeFreeOhio has repeated one of these two "conclusions" in its own fact sheet. When I mentioned this to the group, it responded by noting that the Surgeon General had drawn this conclusion, so it must be true. I pointed out that the conclusion was nowhere to be found in the report itself, but when someone as high up as the Surgeon General makes a statement, it is going to be very difficult to convince people that it is flawed. This is what makes it particularly problematic that the Surgeon General has misrepresented the actual conclusions of the report. There is almost no way to repair the damage.

If we are ready, based on the available evidence, to conclude that brief exposure to secondhand smoke causes heart attacks among nonsmokers, then I submit that we no longer need 727-page reports, or any Surgeon General's reports, for that matter. What is the point of preparing a 727-page report that does not conclude that brief secondhand smoke exposure causes heart attacks if the Surgeon General, followed by hundreds of anti-smoking groups, are going to claim to the public that brief exposures do cause heart attacks? To me, this undermines the need for, and importance, of having sound science to support anti-smoking groups' statements and actions.

Frankly, we might as well just make up the statements we'd like. If we're not going to require solid documentation for our claims, then why work under the pretense that our claims are well-documented by the evidence? Why not just drop the pretense altogether and just state whatever we feel like?

It is unfortunate, but we have reached a point where anti-smoking groups need to actually read the full 727-page report if they want to be sure that any claims they make are accurate and well-supported by the report. It is simply not enough to take the Surgeon General's summary of the conclusions of the report and repeat them to the public. They need to be independently verified, because apparently, even at the highest levels of the tobacco control movement, the desire to produce dramatic claims about the health effects of secondhand smoke has superceded the desire to be careful, cautious, and solidly supported by science.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.